Medicare

Who it is for

People who live in Australia and can enrol: Australian citizens, New Zealand citizens, permanent residents, some people applying for permanent residency, and some visitors from Reciprocal Health Care Agreement countries (usually public-hospital and medically necessary care only — not the full local package).

Private hospital / extras cover is a contract on top of Medicare. It does not replace enrolment. PBS medicines sit beside Medicare, not inside it.

How a consult is paid

The MBS lists a schedule fee for each item. Bulk billing means the doctor accepts the Medicare benefit as full payment. If the doctor charges more than the schedule fee, you may still have a gap after the rebate. From 1 July 2026, bulk-billing assignment of benefit has updated written-agreement rules (episodic or, in some settings, enduring).

Safety nets (out of hospital only)

Services Australia tallies your out-of-hospital MBS costs. Original Medicare Safety Net (OMSN): once gap-to-schedule costs hit the annual threshold, the rebate rises to 100% of the schedule fee for the rest of the calendar year. Extended Medicare Safety Net (EMSN): once out-of-pocket costs hit a higher threshold, Medicare can pay up to 80% of further out-of-pocket costs, subject to item caps. Families need to register so expenses combine. Thresholds index on 1 January.

What Medicare is not

Not a cash income-support payment. Not the PBS (medicines). Not private extras (dental, physio, optical unless an MBS item applies). Not automatic free GP care if the practice does not bulk bill. Not travel insurance for RHCA visitors.

ISSA (1 January 2024) — MBS cost sharing (ISSA 2024, agrees with 2026 Health tables)

100% of the schedule fee for outpatient GP services (bulk billing), 85% for other outpatient private practitioner services, 75% for inpatient private practitioner services (private insurance covers at least the other 25%). Extra reimbursements after out-of-hospital safety-net thresholds. No patient charges for standard-ward public-hospital treatment by staff doctors. Safety-net dollar thresholds are from Health, not this 2024 profile.

Conditions

Enrolment

You must be enrolled and have a Medicare number. Living in Australia plus citizenship, NZ citizenship, permanent residency, or another eligible visa/status.

Listed service

Medicare pays against an MBS item. If the service is not on the schedule, Medicare does not pay — private fees sit outside the safety nets too.

Bulk billing

If the practice bulk bills, you assign the benefit to the doctor and pay $0 for that eligible service. Not every GP bulk bills every consult. Practices in the Bulk Billing Practice Incentive Program bulk bill every eligible patient for every eligible GP service.

If you pay

You pay the practice, then claim. Out-of-hospital, Medicare usually pays 85% of the schedule fee. The gap to the schedule fee (and anything the doctor charges above the schedule) is your out-of-pocket until a safety net applies.

In hospital

As a public patient in a public hospital, Medicare covers admitted care. As a private patient, Medicare generally pays 75% of the schedule fee; private health insurance may cover the rest if you have it. Safety nets do not apply to in-hospital MBS services.

Reciprocal visitors

RHCA visitors are usually treated as general patients. They do not get concessional PBS. Cover is medically necessary public care — not a substitute for travel insurance.

Primary source first. A disputed or stale figure stays visible. Hover a rand or dollar figure for four other currencies. W weekly · F fortnightly · M monthly · A annually.

Cross-checks

• agrees A guide to Australian Government payments Quarterly payments guide lists Medicare as a health payment, not a Centrelink cash rate. Use Health/Services Australia for safety-net thresholds.
• agrees ISSA country profile — Australia ISSA Australia health branch matches MBS 85% out-of-hospital / 75% private inpatient structure. Safety-net dollars from Health 2026, not ISSA 2024.

How to apply

Enrol through myGov or a Medicare enrolment form. A newborn can be added to a parent’s card. Keep the card (or the number in a claims app) with you. Claims for non-bulk-billed services go through Medicare / myGov, often at the practice.

Alongside Medicare

Medicines are a different scheme. Private cover is a contract on top.

Methodology

coreau_ss_methodology.medicare_mbs

MBS schedule fees and safety-net thresholds from the Department of Health and Services Australia. Thresholds index on 1 January. Not a Centrelink fortnightly rate. Change this row in Core AU and the Compass follows.

1. Enrolment and claiming: Services Australia Medicare pages.
2. Safety-net thresholds: Health — Medicare safety nets (OMSN / EMSN), calendar year.
3. Bulk billing practice: Health bulk-billing campaign / BBPIP. A practice may still not bulk bill every item.
4. Cross-check the quarterly payments guide only as a signpost — it does not replace the Health tables.